Setting standards

Toilet paper. First aid kits. Drinking water. These are just a few of the essential supplies one might expect to find in high-traffic facilities owned or paid for by the city that serve more than a thousand people per night.

But San Francisco's homeless shelters, which have been around for about 25 years, have repeatedly fallen short of meeting basic standards or even living up to the policies outlined in their city contracts.

Since 2004, regularly scheduled and surprise spot checks conducted by the 13-member Shelter Monitoring Committee have turned up a range of deplorable and deteriorating conditions in regard to cleanliness, nutrition, and humane treatment of residents  from bloody shower curtains and broken toilet seats to clogged drains and kitchen counters cluttered with dirty dishes. A survey of health and hygiene conditions  from functional sinks to the posting of proper hand-washing techniques  found that only 6 of 19 facilities met basic requirements.

"The Shelter Monitoring Committee makes reports to the Rules Committee, and their reports about conditions in the shelters were very, very disturbing," Sup. Tom Ammiano told the Guardian.

To fix that, Ammiano and a cadre of city staff, homeless-rights advocates, and Shelter Monitoring Committee members are drafting legislation that would require shelters to meet basic standards of care, force compliance through $2,500 fines, and formalize a swifter complaint process.

The Health Services Agency last year had $69 million to spend on housing and the homeless, a portion of which funds nine year-round single adult shelters and four family shelters, as well as four resource centers where homeless people may not find a bed but should be able to access other services, like showers, laundry, phones, and the shelter reservation system.

The management of the facilities is contracted out by the HSA to different nonprofit organizations, including some well-known national groups like the St. Vincent de Paul Society and Episcopal Community Services. The Department of Public Health also handles two of the contracts.

Those contracts stipulate a number of policies, including providing clients with access to electricity for cell phone charging, a guaranteed eight hours of sleep per night, toiletries and feminine hygiene products, first aid supplies, and Spanish translations of printed materials; and a mandate to treat all clients with "dignity and respect."

That doesn't always happen, and the monitoring committee isn't the only watchdog saying so.

The Coalition on Homelessness has been fielding complaints from shelter residents for more than 20 years. A recent increase prompted it to investigate deeper. In May 2007 the group published Shelter Shock, a report based on surveys of 215 shelter residents. The findings: 55 percent of people reported some kind of physical, sexual, or verbal abuse. One-third had no access to information in their native language. Thirty-five percent had nothing to eat.

"The Mayor has actually pointed to these problems as reasons to close the shelters," the report states. "Responsible bodies  the Board of Supervisors and the HSA  have failed to take corrective action. There has been a silence around shelters, giving the impression that shelter residents have been forgotten by the administration and the public at large."

Mayor Gavin Newsom, in his Jan. 8 inaugural speech, identified chronic homelessness and panhandling as high priorities of his second term and promised he'd be "redesigning our city shelter system so that they are no longer just refuges of last resort but spaces where homeless San Franciscans can find job training, drug treatment, and encouragement they need to exit homelessness. We're getting out of the shelter business." At no point did he mention implementing shelter health and safety standards.

James Leonard, a member of the Shelter Monitoring Committee who has spent the past 18 months homeless in San Francisco and San Diego, won't stay in the shelters anymore. All of his possessions were stolen three times. He missed several job interviews because he couldn't charge his cell phone. Frustrated, he hit the streets again. The Homeless Outreach Team found him, officially dubbed him "shelter challenged," and gave him a stabilization bed, which he hopes will eventually transition into a lease in a single-room-occupancy hotel.

He told us the lack of standards contributes to the problem of chronic homelessness because more people would stay in the shelters, off the street, if they were safe and treatment were consistent from facility to facility.

"People keep looking at what's wrong with those homeless people and keep skipping over what's wrong with those shelters and some of those staff members," he said. "It's a system set up to fail unless it has standards."

The issues extend beyond each shelter's four walls. It's a matter of public health for all San Franciscans. "Even if the shelters exist for a minute, they have to be healthy and humane," said Dr. Deborah Borne, medical director of homeless programs at the HSA's Tom Waddell Health Center. "Because if they aren't, they're a danger to themselves and to others."

She cited the example of sitting on a Muni bus beside someone whose bag may be carrying bedbugs. "Everyone in San Francisco is affected by the fact that we have health issues in the shelters."

Borne moved from New York to San Francisco about a year and a half ago. On her fourth day on the job at Tom Waddell, a resident died at Next Door, which houses about 250 people per night and is one of the city's largest shelters. She said the death was not the fault of any specific department, agency, or person, but it could have been avoided if some basic health and hygiene practices were standard for shelter staff and residents.

She brought together several key people, secured $300,000 in funding through HSA director Trent Rhorer, and launched the Shelter Health Initiative, a pilot project that included some of the standards that are part of Ammiano's legislation specifically targeting health and hygiene.

Next Door and Hamilton Family Center participated, were surveyed on needs, and received adequate supplies of things like soap, hand towels, sanitizer, and gloves. "Up to the date of the training, they still didn't have available the basic equipment required to protect themselves," said Jill Jarvie, a public health nurse from Tom Waddell who ran the pilot program.

It's not enough to have cases of rubber gloves and hand sanitizer. They have to be used, and used properly. "Something like a cold virus can stay alive for a couple of days," Jarvie said. Close conditions in shelters compound the risk. "When you're working in a place that sees 300 people a day, how you wash your hands can really make a difference," she added.

Thorough hand-washing techniques and procedures for cleaning up bodily fluids taught to staff trickle down to residents, and so far, it's working. According to Jarvie, Next Door has reported a decrease in illnesses. "It's been exciting to see we can actually do this," she said. The price of the pilot was about $15,000, a cost that would fall over time through bulk purchasing of supplies and as training becomes more standardized. Soon public health officials will be launching another phase, focused on bedbugs and scabies.

An initial budget analyst's report, based on information provided by the HSA, predicted a $6.2 million price tag to fully implement standards throughout the city's shelter system. Many say it's an overinflated estimate based on assumptions that need more vetting.

"We were all stunned by the budget analyst's report," said Quintin Mecke, secretary of the Shelter Monitoring Committee and head of its subsidiary work group on the legislation. "When you look at some of the assumptions, they're just not true." For example, the HSA interpreted security to mean staffing all the shelters with full-time guards, when other mitigations like locks and staff training could be implemented instead.

Mecke and the work group believe that although there will be hard costs associated with the legislation, many are onetime and others are simply the price of complying with what's supposed to exist already. Ammiano's aide Zach Tuller said, "We expect the cost to come in under half a million because HSA claims so many of the services are already being provided. We're looking to prevent slippage."

Dave Curto, head of contract compliance for the HSA, said the department agreed with some of the legislation and was still talking through specifics. He confirmed that policies do exist and shelters are provided with training manuals to enforce them.

"I think they are happening," he said of the HSA policies. "That's why we're a little confused."

A list of those policies is included in the budget analyst's report, which Mecke said sent a conflicting message. "It creates the impression that things in the shelter system are other than what we found," he told a recent meeting of the standard of care work group, which is redrafting some of the legislation in preparation for a February hearing of the Budget and Finance Committee. "We want to be very clear at the Board of Supervisors that they don't come away with the impression that these things exist, because they don't."

Ammiano said this is a necessary first step toward making the shelters more humane, at a time when many assume they already are.

"I think one of the most annoying things that I read was C.W. Nevius [in the San Francisco Chronicle] taking this rather orchestrated Disneyland tour with Trent Rhorer and saying how wonderful the shelters were and then blaming the homeless for not wanting to be in them," Ammiano said. "But obviously C.W. Nevius and Trent Rhorer have something to wipe their ass with."